Summary

Leads a team of contractors who provide expert content and knowledge of value-based care contracting methodologies and negotiation strategies. Emphasis on value-based arrangements with specialty providers in a commercial context, but conversant with all lines of business (ASO, fully insured, Medicare, Medicare Advantage, Individual and Family Plans) and all provider types (PCP, specialists, ancillary, institutional). As a shared service across Evernorth, this role supports all Evernorth Care in their network strategy needs and is integral in the development of those strategies. Uses deep professional knowledge and acumen to advise functional leaders and matrix partners. Creates an Evernorth competitive advantage by becoming partner of choice for providers and supporting a differentiated patient experience.

Key responsibilities :

• Provide direct leadership to the Value Based Contracting team. Provide indirect leadership and support to the Provider Engagement and other teams through which Value Based Program solutions are delivered.

• Be an advocate for both providers and Evernorth in regulatory matters concerning value-based programs and other proposed regulations impacting providers.

• Collaborate across Evernorth product lines to optimize provider and patient experience and leverage Evernorth resources in a cost-effective manner.

• In coordination with Data & Analytics, create and propose new value-based methodologies for deployment to specialists and other providers.

• Working with business line Network Strategy leads in Evernorth Care, create strategies to address network recruitment and contracting needs. Engage directly and be responsible for the contracting effort to meet those needs, which may be either value-based or fee-for-service relationships.

• Ensure that the network strategies of the Evernorth Care entities appear congruent to the provider and are aligned in the resulting contractual documents.

• In coordination with Data & Analytics, Business Development and Provider Engagement, identify targeted providers for re-contracting opportunities. Re-contract all appropriate fee-for-service providers into value-based relationships. Educate team members regarding best practices for determine provider-readiness for advanced value-based arrangements.

• Manage team member work plans for contracting activities and provide on-going status of activities to appropriate Evernorth Care Leadership.

• Prioritize departmental improvement efforts and facilitate organizational design and change management efforts; supports staffing, workflow, and training efforts; optimizes operational and administrative processes.

• Instill and support a culture of rapid prototyping to quickly determine program ROI – drive a ‘fail fast’ mentality.

• Assist in resolving elevated and complex complaints. Research problems and negotiate with internal/external partners to resolve highly complex and/or escalated issues.

• Assist in a variety of projects related to the analysis of claims, clinical and financial data, with a focus on improving financial performance and health outcomes for managed populations.

• Assist with additional Value Based strategic priorities that best meet needs of the group as identified by direct manager.

Qualifications

• Bachelor’s degree preferred.

• 8+ years of relevant industry experience developing value-based reimbursement methodologies, especially for specialty providers.

• Experience recruiting and leading high performing and engaged teams. Success leading remote teams preferred.

• Proven ability to engage and educate targeted providers regarding value-based care models, leading to a deal closure rate that meets adequacy and other business needs OR relevant experience in negotiating value-based agreements from the provider’s perspective.

• Proven contract negotiation skills with a focus on future relationship needs of both parties in addition to monetary terms.

• Ability to communicate complex concepts and insights to senior business leaders and providers in a relevant and actionable manner.

• Demonstrated thought leadership on challenging problems.

• Experience managing high degree of change and complexity across organization and portfolio.

• Extensive experience in the healthcare industry with out-of-network specific experience a plus

• Combination of analytical, technical, and business acumen

• Proven ability to work collaboratively in in complex matrix organizations, external partners, and agile teams.

• Self-motivated, ability to work independently.

• Creative thinker, ability to think outside the box.

• Driver of change that will improve results and/or improve efficiencies of existing processes.

• Must be willing to travel up to 35%.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 145,100 - 241,900 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna .

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.